Touching Base Dr Smith and would appeciate your input
4 Replies
4everhopeful - November 28

Dr Smith,

You asked me to touch base with you regarding how my cycle went using dexamethasone, so I thought I'd let you know how it's gone so far and also to ask for your input :)

I was on 350iu or puregon,( follistim in US?) suprefact 0.2 and 1mg of dexamthasone this time. My response to stims was by far the best I had with me getting 18 follicles, mostly in the 20mm size range. (FSH is 9.5 so was thrilled with this)
Out of the 18 follicles, I got 10 eggs, 9 of which were mature and injected. We had 8 fertilize, and had 2 grade 1-2 (1 being best at my clinic) 5 cell embryo's transfered on day 2 (which is standard practice at my clinic.).

Last time I had 13 follicles on 450iu of Gonal F, and got 7 poor quality eggs and the cycle before had 9 follicles on 375iu of Gonal F and got 5 good quality eggs).

Our other 6 embryo's were grade 2-3 and 3's, and although our clinic only freeze grade 1 embryo's decided to keep them in the lab over the weekend to see what happened, and if there was any chance for frozen.
Anyway I rang this morning and learned that all 6 had arrested and died over the weekend :'( I know they were lower grades but I'm of course worrying now that the same thing could be happening to the 2 I had transfered :-\

My question is, out of a crop of eggs, is it usual to get just one or two front runners, or at least one or two that are capable of making it to blast and beyond in a cycle? Is is normal in a cycle for the rest or all of the remaining embryo's to arrest and die? Like natures way of sifting out the abnormal ones?

Also the two that I had were 5 cells already on the morning on day 2, is that good that they had started to divide again?

Many many thanks in advance for your advice and input :)

Nat :)


Dr Smith - November 28

Thanks for keeping us up to date. Well, the dexamethasone did seem to improve the ovarian response to the stimulating medications. That's good.

My analogy for embryo development in vitro is a horse race. They all start out of the gate at the same time. However, by the time they're in the back stretch, there's a group of front runners and the others are spread out behind. At the finish line (i.e. Day 5), there's only few (say 1-5) out in front and then another group (say 1-4) that cross the finish line on Day 6. The rest do not even finsh the race. As you get older, fewer and fewer embryos cross the finish line. This is also true if there are egg "quality" issues. The embryos that do not finish the race are abnormal in some way and you are right, this is nature's way of sorting things out.

Having a couple of 5-cell embryos on Day 2 is a good sign, but not definitive of continued development. I'm sure if you look into it you'll find that, of the remaining embryos that were left in culture, several reached between the 4 and 8-cell stage of development before arresting. I'm afraid I can't give you any probablity of success based on the limited information you have. Sorry. Good luck.


4everhopeful - November 28

Thank you so much for your prompt answer Dr Smith :)

It's good to know that what happened to the other embryo's is normal, esp for someone in their thirties like me, and that just because the others arrested doesn't necessarily mean that my two best one's will. Although I appreciate there are no gurantees :-\ I like the horse race analogy, my dh will understand that one!

I'm so relieved 5 cells is a good sign, I was worried they might be going a bit too fast and then arrest! Think I've got to stop worrying... this bit is so hard!

Many many thanks,

Nat :)


Mamatha - January 17


I have gone through first IVF now and its been 8 days of Embryo transfer.I have got only 2 embryos transfered on day 2.One 4 cell embryo with 25% fragmentation and other of 2 cell on day two.Please let me know my chances of success.



Dr Smith - January 17

It is impossible to tell you what your chances are because the embryos were transferred at such an early stage of development. At the 2 and 4-cell stage, the developmental potential of the embryos is completely unknown. 25% fragmentation is a little on the high side, but it is not conclusive one way or another. Sorry. I just don't have enough information to advise you.



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